Pre Pregnancy Consult with Peri

Ok, I want to sum up my pre pregnancy consult with my peri today.

I have to say that I visited his office twice and they didn’t think anything was wrong with my cervix (that was at 13 weeks and 14 weeks). Less than a week after my last visit and I went into preterm labor.

I never had met him – as he never came out to greet me but assured me that he looked at my u/s’s at the time of my 2 visits. Sure. I guess then I can’t blame the nurse who told me all was OK.
He agrees I need a cerclage –although he said that most times they won’t disagnose IC until 3 losses (!!!!!). Before I talked to him, I talked to the nurse (same nurse who twice told me I was fine). I told her that I had not heard back from my obgyn regarding the results from placenta analysis and mini autopsy on the baby. She quickly called them to fax that over.
Well, the dr. went over what they said they found - intra-amniotic infection – is that the same as Amnionitis? No chromosomal problem. But he thinks the infection was caused by IC. Thank God he agrees to do the cerclage. He said that usually IC happens later – I lost my baby at 15 weeks 2 days – baby was about 16 weeks in size, BUT he thinks it is related to what I had because of the intra-amniotic infection and the scare I had at 13 weeks where they thought my cervix was opening from the top.

These are the questions that I asked:
What type of cerclage would I get?
Nurse said he does McDonald, He said he does a mix of McDonald and Shirodkar.

Do you do the cerclages?
Yes, he does them. He went on to say he has done 1000 of them and only lost 2 babies. I find that hard to believe but whatever. He said there is only loss in about 1 out of 200. He kinda told me that the 2 that he lost – one was twins born at 24 weeks and the other was a lady in an accident. I thought they would be more related to infection after the cerclage. I really wonder how they come up with these statistics.

When to get it as I had funneling at 13 weeks last time?
He said they can do it between 12 and 13 weeks, after NT scan is done at 11 weeks. He said ‘well we just don’t want to sew it a baby who has issues’.

Antibiotics before/after cerclage?
He said during cerclage and after, but not before.

How will I be treated if I have PTL? They don’t really give progesterone shots weekly. Damn. Really he said they will only give terb at 24 weeks of after.

How often will he see me?
He said once a month after cerclage. So if I also see my obgyn then at least that is every 2 weeks. Somewhat negative. He just says if the stitch isn’t holding, they can’t do much. Well, what about recommending bed rest, you idiot!!

Schedule for our visits?
8 weeks
NT at 11 weeks
Schedule cerclage 12 weeks – 13 weeks
Follow up after cerclage – 2 weeks after
Then seen by him once a month.

Can I chance twins?
Since I did IVF for the first baby – the one I lost, I’ll probably have to do IVF again. We have male factor and plan to do a frozen cycle in the next 2 months. I asked him about twins and he said it is ok for the stitch that he does. He said he has had triplets and quads. He was just ‘well, we can do twins if you want to take the risk that twins bring, but you know transferring 2 can lead to 3 babies, etc’. I asked him if he does a different stitch for twins, he said no. He said twins average 32 weeks from what he has seen at his practice.

Blood disorder testing?
Doesn’t want to do it on me, doesn’t think I need it. He said what happened to me was not inline with blood disorders affecting the baby. I know this is done for repeat pg loss, but I’ve also heard of it causing 2nd tri m/c’s. I also think I am a carrier of the sickle cell anemia trait. I’m not sure though, but my sisters are. I have not been tested.

Bed rest?
Only 2 weeks after cerclage – after that NO BED REST. I’ll do my own modified bedrest, I think.

Other comments made by him:
1/10 losses in 2nd tri are due to IC.
He thinks progesterone only bring people’s chances up from losing a baby from 1 out of 3 to 1 out of 2. He is not a big believer in bed rest or progesterone. Negative on my part.
He was very passive about me having PTL while having the cerclage.
I asked him what happens if I start having contractions with the cerclage. He kinda said ‘well that usually doesn’t happen, but if it does we can’t do much – baby would be born if there is an issue with it’.
I asked him about checking my cervical length and he said they normally don’t do that to compare to previous measurements, they do the u/s and look at the cervix but with the cerclage they just think it should be ok. I asked him about funneling to the stitch and he said that shouldn’t happen. I even asked ‘well what about right before the person is due when the baby is really big’, he said no. Rolling eyes here...
Cerclage comes out at 36 weeks
Steroid shots could start as early as 24 weeks to develop, lungs, brain and intenstine.

I have mixed feelings. I think I want to keep him as if I switch him out I pretty much have to switch out my obgyn. I like my obgyn and I feel confident that this peri can do the job. He acted like none of his patients ever have an issue. Well, in that case I want to be one of his patients. :)

I'll talk to my DH tonight and see what he thinks. He couldn't take off to go today with me.